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Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

Authors
 Sungsoo Cho  ;  Tae Soo Kang  ;  Jung-Sun Kim  ;  Sung-Jin Hong  ;  Dong-Ho Shin  ;  Chul-Min Ahn  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Young Bin Song  ;  Joo-Yong Hahn  ;  Seung-Hyuk Choi  ;  Hyeon-Cheol Gwon  ;  Myeong-Ki Hong  ;  Yansoo Jang 
Citation
 JACC. Cardiovascular Interventions, Vol.11(13) : 1247-1258, 2018 
Journal Title
 JACC. Cardiovascular Interventions 
ISSN
 1936-8798 
Issue Date
2018
Keywords
bifurcation lesion ; left main coronary artery ; percutaneous coronary intervention
Abstract
OBJECTIVES: This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment. BACKGROUND: Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions. METHODS: A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes. RESULTS: During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis >/=50% were significant independent predictors of MACE. CONCLUSIONS: Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.
Full Text
https://www.sciencedirect.com/science/article/pii/S1936879818307180
DOI
10.1016/j.jcin.2018.03.009
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
고영국(Ko, Young Guk)
김병극(Kim, Byeong Keuk) ORCID logo https://orcid.org/0000-0003-2493-066X
김중선(Kim, Jung Sun) ORCID logo https://orcid.org/0000-0003-2263-3274
신동호(Shin, Dong Ho) ORCID logo https://orcid.org/0000-0002-7874-5542
안철민(Ahn, Chul-Min) ORCID logo https://orcid.org/0000-0002-7071-4370
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
홍명기(Hong, Myeong Ki) ORCID logo https://orcid.org/0000-0002-2090-2031
홍성진(Hong, Sung Jin) ORCID logo https://orcid.org/0000-0003-4893-039X
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162619
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